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with advanced HF, it can act as a “bridge” for further invasive treatments (e.g., HTx or MCS) for others.
It must be clear that the final goal to perform such interventions in this setting of patients is no longer
reducing mortality of course, but to enhance and/or stabilize the clinical status (mainly by reductions of
sPAP) and thus the quality of life while awaiting HTx. Consequently, obtaining a symptomatic benefit
increases the chances of reaching HTx in a good enough clinical status. More research efforts need to be
spent to understand who will more likely benefit from percutaneous mitral valve repair at this stage of the
HF. Currently, it is recommended to early refer patients affected by advanced HF to tertiary care centers
that can best individualize treatment options (HTx, MCS and bridging solutions) and assure the proper
timing for their application.

CONCLUSION
MitraClip implantation in advanced HF patients with concomitant severe MR is safe and can provide
significant clinical improvement. Available evidence describes the favorable outcomes obtained with
this device resulting in BTT, BTC or BTR. Further studies are needed to investigate the predictors of
success for this procedure in this extreme setting of patients in order to provide solid basis for treatment
recommendations.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study and performed data analysis and
interpretation: Scotti A, Godino C
Provided final revision and administrative support: Margonato A

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

REFERENCES
1. Iung B, Vahanian A. Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol 2011;8:162-72.
2. Sannino A, Smith RL, Schiattarella GG, Trimarco B, Esposito G, et al. Survival and cardiovascular outcomes of patients with secondary
mitral regurgitation: a systematic review and meta-analysis. JAMA Cardiol 2017;2:1130-9.
3. Godino C, Scotti A, Taramasso M, Adamo M, Russo M, et al. Two-year cardiac mortality after MitraClip treatment of functional mitral
regurgitation in ischemic and non-ischemic dilated cardiomyopathy. Int J Cardiol 2018;269:33-9.
4. Goliasch G, Bartko PE, Pavo N, Neuhold S, Wurm R, et al. Refining the prognostic impact of functional mitral regurgitation in chronic
heart failure. Eur Heart J 2018;39:39-46.
5. Adamo M, Godino C, Giannini C, Scotti A, Liga R, et al. Left ventricular reverse remodelling predicts long-term outcomes in patients